Growth hormone deficiency diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Although GH can be readily measured in a blood sample, testing for GH deficiency is constrained by the fact that levels are nearly undetectable for most of the day. This makes simple measurement of GH in a single blood sample useless for detecting deficiency. Physicians therefore use a combination of indirect and direct criteria.
Diagnostic Criteria
Several types of evidence are used to ascertain GH sufficiency or deficiency.
- Auxologic criteria (defined by body measurements)
- Indirect hormonal criteria (IGF levels from a single blood sample)
- Direct hormonal criteria (measurement of GH in multiple blood samples to determine secretory patterns or responses to provocative testing)
- Response to GH treatment
- Corroborative evidence of pituitary dysfunction
For GH deficiency, as for many other diseases, the practical purpose and effect of these diagnostic criteria is to determine who is to be treated with it. GH deficiency accounts for only a minority of short stature among children. GH deficiency accounts for an even smaller proportion of fatigability, excessive fat, osteopenic bones, and underdeveloped muscles in adults. An ideal diagnostic test cleanly separates people who would benefit from a treatment from those who would not. Unfortunately, none of the criteria listed above do so, not even in various combinations.
The common clinical problem is that many children and adults being evaluated meet some, but not all, of the above criteria. Since many children and adults who do not meet all of the diagnostic criteria may receive some of the benefits of treatment, small differences in the diagnostic criteria make large differences in the number of short or tired people diagnosed with deficiency.
Because of uncertainties and complexities of diagnosis and the high costs of treatment, diagnosis of growth hormone deficiency has been a more persistent subject of debate and controversy in clinical endocrinology than any other aspect of endocrine diagnosis. It has become a major type of internet fraud {HGH quackery}.